Healthcare Provider Details

I. General information

NPI: 1124115092
Provider Name (Legal Business Name): WASHINGTON SQUARE ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ 4TH FL
PHILADELPHIA PA
19106-3500
US

IV. Provider business mailing address

230 W WASHINGTON SQ 4TH FL
PHILADELPHIA PA
19106-3500
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3561
  • Fax: 215-829-5654
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS J DUFRAYNE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 215-829-3561